Healthcare Provider Details

I. General information

NPI: 1619764412
Provider Name (Legal Business Name): MISTY ZINSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 IVY ST
SAN DIEGO CA
92104-5532
US

IV. Provider business mailing address

3048 IVY ST
SAN DIEGO CA
92104-5532
US

V. Phone/Fax

Practice location:
  • Phone: 619-929-7729
  • Fax:
Mailing address:
  • Phone: 619-929-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number95031287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: